Dental therapeutic indications for the newer long-acting macrolide antibiotics.

When treating oral infections, clinicians have used the macrolide antibiotic erythromycin as an alternative antibiotic for patients who have documented allergic reactions to penicillins. In this article, the author reports on his assessment of the pharmacology of erythromycin and the newer macrolide antibiotics, as well as of their indications for the prevention of bacterial endocarditis and their possible use for oral-dental infections. The author reviewed the current clinical pharmacology literature with specific emphasis on reports indicating these antibiotics' efficacy in treating oral-dental infections. Azithromycin, clarithromycin and dirithromycin are erythromycin analogues that are currently marketed in the United States. All three have the therapeutic advantages over erythromycin of longer durations of action, enhanced acid stabilities and improved tissue distributions. A lower incidence of gastrointestinal distress and abdominal cramping is reported for all three of these newer agents than for erythromycin. Azithromycin and dirithromycin do not appear to compete for the same hepatic drug-metabolizing enzymes as erythromycin and therefore are not associated with the same drug interactions. The newer macrolide antibiotics offer the advantage of fewer adverse gastrointestinal effects than erythromycin and dosing regimens of only once or twice a day. Yet, the extremely high price of the newer macrolides compared with that of erythromycin limits their routine use.